PROPHYLAXIS COMPLEX OF PLACENTAL DYSFUNCTION AFTER THE INFLUENZA TRANSFERRED IN THE EARLY STAGES OF PREGNANCY
Aim of the research: to increase the effectiveness of tactics for the presence of placental dysfunction in the background of influenza by developing and implementing a pathogenetically sound set of treatment and prevention measures.
Materials and methods. Test the effectiveness of the proposed set of treatment-and-prophylactic measures, 80 pregnant women were selected after influenza transferred to early pregnancy: 40 women whose pregnancies were optimized tactics (main group) and 40 women (comparison group), which were conducted according to clinical protocols of the Ministry of Health. The cytotoxicity of natural killers (NK) was assessed by flow cytometry. The level of cytokines in peripheral blood was studied by enzyme-linked immunosorbent assay: interleukin-1 (IL-1), interleukin-10 (IL-10). The study of 25-hydroxyvitamin D, 25- (OH) D was performed by enzyme-linked immunosorbent assay. Determination of serum hormones was performed using standard kits for immunoradiometric determination.
Results. Homeostasis in the first trimester of pregnancy after influenza is characterized by disorders that reflect further plantar dysfunction: a list of NK cytotoxicity, proinflammatory changes in the cytokine profile, the procoagulant state of the hemostasis system. Optimization of conservation in such tactics is the use of pathogenetic and preventive measures, treatment and prevention measures to prevent placental insufficiency and reduce the negative effects of hyperimmune reactions (aspirin, dipyridamole, progestogens, intravenous immunoglobulin, vitamin D). The use of the recommended set of measures has a positive effect on hormonal functions of the placenta (normalization of progesterone and estradiol levels). Immunity also improved: one month after starting treatment with NK lysis 1:10 decreased from 24 [15; 30] to 17 [13; 21] (p <0.05), the balance of the cytokine profile was manifested in a decrease in the ratio of IL-1 / IL-1 from 1.36 [1.12; 2.51] to 0.82 [0.42; 1.16] (p <0.05). The proportion of women with suboptimal vitamin D levels decreased significantly from 87.5% to 37.5% (p <0.05), and in cases of deficient conditions it was possible to bring the level of vitamin D in the blood to optimal or suboptimal. Reduction of Willebrand factor from 1.54 [1.38; 1.74] to 0.92 [0.68; 1.08] IU / ml (p <0.05) indicates an improvement in endothelial function, which in turn creates favorable conditions for the development of the feto-placental complex. The use of the recommended management of pregnant women after influenza in early pregnancy has reduced the incidence of placental insufficiency by almost 2 times, which was diagnosed in 13 (35.0%) women in the main group against 25 (62.5%) patients in the comparison group p <0.05).
Conclusions. The use of the recommended set of measures has a positive effect on hormonal functions of the placenta (normalization of progesterone and estradiol levels), immune status (reduction of NK cytotoxicity, cytokine profile balance), elimination of vitamin D deficiency and reduction of procoagulation potential of hemostasis. Creating favourable conditions for the development of gestation can reduce the incidence of placental insufficiency by almost 2 times to 35.0% vs. 62.5%.
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